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Gastroesophageal Reflux Disease (GERD)

  • What is gastroesophageal reflux disease (GERD)?

    GERD
    Gastroesophageal reflux disease (GERD), also known as an acid reflux or heartburn, is a chronic digestive disease. It occurs when the acid from the stomach flows back (reflux) into the oesophagus (food pipe). This acid reflux irritates, and can sometimes damage, the lining of the oesophagus. It can also reach the vocal cords, or even flow back into the lungs.

    In normal digestion, the muscular valve between the stomach and the oesophagus (food pipe), known as the lower oesophageal sphincter, opens to allow food to pass into the stomach, and closes to prevent food and acidic stomach juices from flowing back into the oesophagus.

    Every once in a while, it is normal to experience acid reflux, where your stomach contents flow back up into your oesophagus. However, if this occurs more than twice a week for a few weeks, it could be a sign of GERD.

  • There is no identifiable sole cause of gastroesophageal reflux disease. GERD usually occurs when the muscular valve between the stomach and the oesophagus, is weak or faulty. This allows the stomach acid to flow back into the oesophagus.

    Risk factors for GERD

    Conditions and factors that can lead to the onset of GERD or aggravate acid reflux include:

    • Increased abdominal pressure due to being overweight, obese, or pregnant
    • Certain diseases (Zollinger-Ellison syndrome, scleroderma)
    • Hiatal hernia, a condition where the upper part of the stomach moves up into the chest through an opening in the diaphragm, which lowers the pressure in the oesophageal sphincter
    • Increased production of gastrin, a hormone that regulates the release of stomach acid
    • Certain foods and beverages, such as fried, spicy, or fatty foods, chocolate, peppermint, coffee, or alcoholic beverages
    • Smoking or inhaling second-hand smoke
    • Use of certain medications, including asthma medicines, calcium channel blockers, antihistamines, painkillers, sedatives, and antidepressants

    Preventing and managing GERD

    Several lifestyle changes and over-the-counter medications can be taken to control gastroesophageal reflux, and prevent or reduce the risk of the condition turning into a chronic disease. These include:

    • Avoid consuming certain trigger foods and beverages, such as fried, spicy, or fatty foods, chocolate, peppermint, coffee, or alcoholic beverages
    • Avoid overeating
    • Not eating 2 to 3 hours before bedtime
    • Losing weight if overweight or obese
    • Taking over-the-counter medicines, such as antacids, for mild GERD, and H-2-receptor blockers or certain proton pump inhibitors for chronic, moderate GERD
  • The most common symptom of GERD is heartburn, which is a burning sensation of the chest that spreads from the stomach to the throat. Other possible symptoms of GERD include:

    • Bitter taste in the mouth (acid regurgitation)
    • Bloated stomach
    • Burping
    • Feeling of a lump in the throat
    • Hoarseness of voice
    • Pain and difficulty swallowing
    • Pain or discomfort in the chest
    • Persistent cough
    • Persistent sore throat
  • If you experience frequent acid reflux, your doctor will first review your symptoms and medical history and suggest several lifestyle changes or medications to address the underlying problem.

    If the interventions do not improve your symptoms, your doctor may recommend testing you for GERD. Among the tests that may be done are the following:

    • Endoscopy to closely examine the lining of the upper gastrointestinal tract and a biopsy if necessary
    • Upper gastrointestinal series to find problems related to GERD, such as hiatal hernias, oesophageal strictures, and ulcers
    • Oesophageal pH and impedance monitoring, which measures the among of acid in the oesophagus while you go about your normal routine
    • Oesophageal manometry to check for weak sphincter muscles
  • There are different treatment options available for GERD, which depend on the severity of the condition. Your doctor will evaluate your condition and suggest the most suitable treatment:

    Lifestyle and dietary changes

    • Avoiding eating late
    • Avoiding food that induces your acid reflux
    • Eating smaller meals
    • Maintaining a healthy weight
    • Quitting smoking
    • Raising your pillow
    • Wearing comfortable clothing to avoid pressure on the stomach

    Prescription medications

    If you experience moderate-to-severe GERD symptoms that are not relieved by lifestyle changes and over-the-counter medicines, your doctor may prescribe certain medications for your condition. These prescription medications may include:

    • Several types of proton pump inhibitors to lower the amount of acid made by the stomach
    • Prokinetics, which help accelerate stomach emptying

    Surgery

    Surgery may be recommended if your GERD symptoms fail to improve with lifestyle changes and medicines. These may include:

    • Fundoplication. This surgery is done using a laparoscope and is the most common surgery for GERD. The goal is to increase pressure to the lower end of the oesophagus and reduce reflux. It often leads to long-term reflux control.
    • Endoscopic techniques. Endoscopic sewing and radiofrequency are procedures done using an endoscope to tighten the sphincter muscle. These newer procedures may be suitable for certain patients.

    Speak to a gastroenterologist to learn more about GERD and to find the most suitable treatment for your condition.

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  • Sometimes, GERD can lead to complications such Barrett’s oesophagus, swelling of the vocal cords, lung damage, stricture of the oesophagus, and oesophagus ulcers.

    • Barrett’s oesophagus is a change in the oesophagus tissue caused by long-lasting GERD and increases the risk of oesophageal cancer
    • Swelling of the vocal cords is also known as reflux laryngitis
    • Lung damage may include pulmonary fibrosis and bronchiectasis
    • Stricture (blockage) of the oesophagus is caused by scar tissues that develop due to repeated ulcerations
    • Ulcers in the oesophagus is caused by burning from stomach acid
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